Srinagarind Hosp Med J 1989; 4(1) : 37 - 42 Condyloma acuminata in pregnancy fay dousedndana mningamani-uitrviner nnuzunnominad aoninedovewutty Pichai Lueprasitsakul M.D. Khon Kaen University Condyloma acuminata in pregnancy Department of Obstetrics and Gynaecology, Faculty of Medicine, Condyloma acuminata in pregnancy is not rare. It can cause many signi- ficant complications such as mechanical dystocia, increased incidence of both mater- nal and fetal infections, vaginal hemorrhage and genital tract trauma. Furthermore, it may involve in carcinomatous changes of maternal and fetal genital tract and tracheobronchial papillomatosis in children. ‘A variety of treatment methods have been tried during pregnancy with varying success and some methods may cause maternal and fetal morbidity and mortality. ‘The aim of treatment is to eradicate the lesions as much as possible before Inbor and delivery which may reduce the prevalence of respiratory papillomatosis, in children, ‘Long-term follow up in both mother and fetus is necessary for early detec- tion of possible neoplasia of lower genital tract. anudriquazssnainey yanaoulh (condyloma acuminata) 1iy yaviioniedutnd Woyniommiazia oinema Aduuazmranin mmgvosdsa sinertbiawiianidundu papova virus éo human papilloma viruses (HPV s) nisfiagiodyy YojuiavnmstawnA vseaneraoduena wiofouns 65 vougdurldlanozifingansorls usvezion® = wuhsoulsntindlna mansachunomielatuniisoslmut sey anvvosselauindudsssna 2-3 ow (1-9 Mou) — desuilduatabiyansoulilada ‘Bus odors msdnituiintdluios— fgoa mnwdndsa oudaquiuia uazccd anegiqutuiaeld gidimwedsedaa ‘hina udidualivdoeounndy dhltqiuluiempum Tsadsinnacdhigly anidnssAudosnyansovliossinndlaty uaénounianndu dsoredaynadoms ndsamavesnaon msinwiiilAmnuazuns otrsoredeliiiaduanudosnamuazmsn uns lusarhumanondidhinnnsdionen ‘Weamsnusmialé daitiiayauion Adosdusvosian (laryngeal papilloma) 14 svozdow,, NNeuningourewser 1. yansoulistunaladuuazsiw taindu® Taunmeluseusthvveans diana dotutunaninsevugiqudud wlduil nario cell-mediated immunity nA Yoo wazdotufavinniinadiuuves doniiiaduodianmibhamy yaraould Auiialugjalnesvavniadanisnavani sdoannn (mechanical dystocia) MINADANTY doannonoroniiiiamsanidonquunms dosnnonniosninyanaorlsiiimscsiilonde © wenorniduwa Aduowesuunnioamammnuveduadlsd ‘aunsovostiandoela' unsunenuordiin fistula seer hadoannondiy mianin (rectovaginal fistula) yansoule dadunelugisdamnatomsidiu msvuche daaneuazgoviss msinuryansowlsviad anal usewhamsdanssfonotelhiin dunnorogihy wu mndonquuss vto tiamsdniauaadtopiun Dudu 2, madniaudaovinanhindosnaoa WazdoINaDA (Vulvovaginitisy willérion sduaduniiowas fis atu: se. - fle. 2532 aimsdiiqgte anvandwniy susemw iMoauaziba lunevidanvnnduintuue ‘hidlusarinifamints Trichomonas vaginalis mrdniauiiartodandauenvinecdoliuia oimunmeit nionitis $#2oroqneansignrucidonluiiga orsituroifinves chorioam- 3. ustinhnvesnaon vosnaoauay inwagn Gquemous cell carcinoma of vulvs vagina and cervix) ginnisAinwimassuIAIM wh anivivinto HPV s type 16, 18 uaz 31 0 énmudowiomnaausdahmyosnaon (vulvar cancer) UazusidavinuAgn (cervical cancer) ons nddadnununniausieyoanaon (vaginal cancer) iiamaundamafmgentsouls ‘bh usrinyanaonlivneiinein HPV s Hbidorgoatumnia uziwossuvduiug uMumalgiisiny type 6 wae’ 11 ‘himansoventawiaves HPV s vidluming stefan Aes YW aztuanindiimsldiumianemelu obtanhiauomoitiiefamaiiauerdamandn pVeunIngoudomsn 1, madmaudadolumsnvaciiy 731 (Intrapartum fetal infections) an wHga maumndvoagainh —_uazifia chorioam- nionitis mann dofidhminendhuinintly dosnaonuazmnismin® 2. yanvoulivinaoiuzmad 07 tdushausiusniia Iviumanviosednusiny Wriow 8. YAlszuUNIUAUMUT® (Respira- tory papillomatosis) quamswulétieunh 1 (3) . doa sia 1,000 nu dotite HPV s ene chonoasimunaihiqmartserrhamanaonVol. 4 No. 1 Jan, - Mar. 1989 (vertical transmission) 19-412 tilossinyely seuumadumelovoudnndibinessfagin HPV s type 6 way 11°" ahudeativya waoulilusnim? szuewnsiauesdsnoron: anwmidunammsdunzinesifurindes- 1dua (laryngeal papilloma) usiduduvoamna— aumnlofonesihilé msgarhvoamaau indlohumeumngouruus? vineio msinnuasinesifiadmendamsinn yh Vidosiumsinynios ye" 4, uziinhndoanaon uitingensouls VinwoTemAMuudMuinvenvld tos udiinununaiasednhndosnaonluand Sofu 2 nu (ory 24 J) daddseiaidu yamsorlisaudusniia® mthaams manmdiiliasdanudigy msivodu dhulgpinoroudntonlsesaneritus Duriumnewnynuthtanlodwanyndionsorls Vnnwoinewa Aduvfosoumsin vs dnguniodianomanndiner szviersan tamidhinuhiddehunridedonieluse idoromsinn msdmnatuniososnsvh Saunrnuszsiasstatiosein mitotic activity ainoxiMushdussehadanysA msvh Pap smear Judthopnnedanresenuisadiiannaorn UinuAgn — (cervical intraepithelial neoplasia) (cervical msdeanfosanerhinsagn (colpo- afonundngnagauzaanhnuagn warts) scope) orniinnuduthiumsivdodoyauiiom thnuagn nlewmnsodlsnfinanhinozwn aw Indithuuadhidénwnsinounsonls Srinagarind Hospital Medical Journal 39 madesndosmneluviaticane (urethroscope) Wazlundiaiin (anoscope) ozvivisoIvi1 tandunwidsoulsadosiuinnsou9 vie aemeuaemnonin wenvimimsanon Isnaviomameaninédus shinoewutay ‘Wurl modu @ilia trichomonas vaginalis uae chlamydia usin MsIvesdununlsa sdvin(lAur 1. Condyloma totum ishusoulsnsany ‘Whazuvisowostléa matinnevfuun TunnssvitlAlaunnewuila Treponema pall dum Taundosqanssei dark-ground Wazms ansidonlavi® Nontreponema (If VDRL) Way Treponema (ivH FTA-ABS) danelina wirhufeuynns 2, yatnqn (Molluscum contagiosum) Adnworzifuguudaindyn assnanasa sour (central umbilication) fdUawitiy avfinmniansinmagahitneonudsiug 9: dutioyadun 9 ndiingnoomn 3. Granuloma inguinale Tiiosiléninms Wright's Giemsa’s stain UYU Donovan bodies iiinwmy: Paes Goutuovidannunaday uae Aaddintmuaosthandadiundnayly cy- toplasm ¥®1 macrophage Hamunsawulé 90- 95% o1nuNa re a 4. Moronwiassuanvoseuuduing (ti vulvar adenomas, endometriomas, fibromas Way lipomas udu 5. ustiauoahndeanaea = voanaoa wiothoungn40 siuaduniowas mio masinwngansoulnwucusdansshinlA nalidniins Jinsinwduoysusne 9) maine shumisuazdmauvossoslse! uikoorlAidy 238 fo maine tamieduasmsiowmadaunysa ioums inuryansoultinasinwimséniaudardely dosnaonroutuinnud dua AnwrnnwazoauIMinvoswmaen mismudraiosnaoatutunisinwuine m3 uns tnndosnaoabturoresengadamsloues yanrouls fuastnuusimoimssemuiies tameiihiviouas 4. mainndawmnmuerwnet 1.1 Podophytlin 10-25% lu tiacture benzoin Huilvluandnssd slowinsoelsn Sindunelug uazihonsmdordosnn wWWimgngaduth¢nssumdonladw da otsifnduanudonseuarmsnlunssC” qréthafeduansm ‘Wurl usundouuse sedulluanfouuazunadesludondy Susana uasidediaG? duqnitna lvdumsnontitimnmduand’? won siniléanuh podophyliin Wilamnanions udthilelummanos Inseuendinaonya waauldanezilunradnaauazvansiers semidh) — luneiseslsebinusthowts po- dophyllin inwilé dindusovlanisidueh quinmaninnd 2 isuauias mil¥ podo- phylin ainehilawad iesniniiamsme voasoulsnlsinan (incomplete necrosis) 141 ‘indosoclsndainezhinouduoaiom ag podophyllin Iuszurdewuazoinduvoiia 4 atiuti1 ante, 232 voamsdmaudardolauiansininiwiad ‘hidvoondion asihihunoiidsoolavna Susimrinandaeimariaunsns 1,2 5 - Fluorouracil a2 Bleomycin slam duilgluaniiinss’ vleswinithuiy dosaduavdqnidudamsuiadavousad Undérw dovrielbiiiadunnedomarly asad Mlunseivsimsgaduenshdarsumdon dordudnusemisfomunadidsoredosinn aymudoudindlana 1.3 Trichloroacetic acid WIAs danssAudosoinstitiisoolsauvigudarurids ‘hidmagaduoutidnssumdon — Foafo ‘bhha ‘hihmovledesatuauachitin tiamsdmay — Taurithlestéthoviitenn Wady 10-50% usnanununinhen iitnmatadn e5y Twain doudurto mafadivoryanseuls wiléiou tune novunudanmanusoslsandaninmeilé wlustouns 20-30% daseamordiya 4 710 Tu 2. mainsmedaanssy 2.1 msaaroulsnoen (Surgical ex- dislony® Wlamuneisoelnihayow yn soolindunialugi himalsiédutossinidy omnnuanivilsoounaunelngjiindy 2.2 msddaulvlih (Electrocoagula- tion) TAnadlaviamesouliaiiduniadn Soidvsorindosnaoninevwnauazownide sdonannnnsoelndnnetang 2.3 msd@auanmidy (Cryother- py) 52) ‘anaddniuyansoulivwiadn fodiidhhheniohation toda dunaunnVol. 4 No. 1 Jan. - Mar. 1989 Srinagarind Hospital Medical Journal 4 mufiadinaléion auazamudubienyisn aiudolaadla 2.4 myinwnAawiacwe’ (CO, laser therapy)"7212329 19 1AAtusoelsnviauia Ane luanidassAvdosindudontion io muuihudfumahawiamesoeladibiiia Sumnudonlodotruies — unauhution tlossinmansomuquazdunnsdinvesms yhodla marion favitidlnnsonainiduamsaueneiay uaerhuaavemudindiieu Vviowimhaviounneiasosiinadiodnw dsvmnmAaw Ferencey nustunadrishs mrinndafooae 98 vinmlsiavofinw yorsouliudniiinss doiduvoimslg insoifio indoslosnmunauasidunan tumah MUAONIAADA (Route of delivery) Ju offiuana shuns uaeiauveryarsoult ‘Tuilogiueziorsonehsiavinavamantiios tamslusieriseulsadunieligtavnasio nisnavanndosnaomiioluniuviminaen maveanaonvsihiiiamsanenquuss matoinaen — unamlduuunvioiia fistula sewhadosnnoatunnsin ‘Liuusth ‘Vidhtiamnavamantmedudiuynsie nloanindanmafayelumaudwnelowes unemsehdavhnnenoiey ‘bishudoarhunathunoaufovinunsengmsn? miniibisnn® ag yansouldidanndiqlvaniiasss udoaninorndavnadamsaaaamstosnaoa tihuleiinveansfagorduansmuazmsn shumomqvosmannifoamadosnaon—snanfa Wiaduansiovesmanaon wensiniiors idurfostiuninfansisuseuuduituyues Hunsmuazmisnuazmsifagelumady wndlovoamisrluszuzsion sortase Mandobiims maim unoduornoltifiaduanolossaua: snmdmanowinnsodlsllinual foumsdunrsAucemannoa daowvssn AAQUAMIVOAySUMAAUMIdVeINIIN mainwily min mathiamusmuarminlussoserdy dadriqivennommedassuuduiugly aeusiudu tonensd1da 1. Barrett TJ, Silbar JD, Mc Ginley JP : Genital wart-a venereal disease. JAMA 1954; 154 : 333- 4 2. Oriel JD : Natural history of genital warts. Br J Vener Dis 1971; 47 : 1-13. ‘3. Centers for Disease Control : Condyloma acumi- atum-United States, 1966-1981. MMWR 1983; 932 : 306-8, 4, Gorthey RL, Krembs MA : Vulvar condylomata acuminata complicating labor. Obstet Gynecol 1984; 4:67-74, 5. Young RL, Acosta AA, Kaufman RH : The treat- ment of large condylomata acuminata complica- ting pregnancy. Obstet Gynecol 1973; 41 :65-73 6. Reid R, Greenbery M, Jenson AB, et al : Sexually transmitted papillomaviral infections. |. The anato- ‘mic distribution and pathologic grade of neoplas- tic lesions associated with different viral types. ‘Am J Obstet Gynecol 1987; 156 : 212-22. 7. Beck |, Clayton JK : Vaginal carcinoma arising in vaginal condylomata-case report. Brit J Ob Gyn 1984; 91 : 503-5. 8. Shah K, Kashima H, Polk BF, et al Rarity of ‘cesarean delivery in cases of juvenile-onset res- 9. 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Stephens CB, Amold GE, Butchko GM, et al : ‘Autogenous vaccina treatment of juvenile laryn- ‘geal papillomatosis. Laryngoscope 1879; 89 : 1689-86. Hahn GA : Carbon dioxide laser surgery in teet- ‘ment of condyloma. Am J Obstet Gynecol 1981; 141 : 1000-8. Chamberlain MJ, Reynolds AL, Yeoman WB : Toxic effect of podophylium application in preg- nancy. Br Med J 1972; 3 : 391-2. ‘Slater GE, Rumack BH, Peterson RG : Podophyt- lin poisoning : Systemic toxicity following cuta- ‘neous application. Obstet Gynecol 1978; 52 : 94-46. Oil UD : Genital warts. Sex Transm Dis 1877; 21. 22. 24, 25. 27. ia atiut1 ae.- fle, 2532 163. oid R : Superficial laser vulvectomry. | The etica- cy of extended superficial ablation for refractory and. very extensive condylomas. Am J Obstet Gynecol 1985; 151 : 1047-82. Gabriel G, Thin RINT : Treatment of anogenital warts : Comparison of trichloracetic acid and odophylin versus podophylin alone. Br J Vener Dis 1983; 59 : 124-6, (Oriel JO : Genital warts. Sex Transm Dis 1981; 8 328-0, ‘Ghosh AK : Cryosurgery of genital warts in cases in which podophylin treatment failed or was con- traindicated. Br J Vener Dis 1977; 3 : 40-53, Reid Fi: Superficial laser vulvectomy. I. A new surgical technique for anpendage-conserving ab- lation of refractory condylomas and vulvar in- traepithelial neoplasia. Am J Obstet Gynecol 1985; 152 : 540-9. 3. Reid R, Eifont EA, Zirkin RM : Superficial laser vuivectomy. I. The anatomic and biophysical principles permitting accurate control of the depth ‘of dermal destruction with the carbon dioxide lager. Am J Obstet Gynecol 1985; 151 :261-271. Ferenczy A : Treating genital condyioma during pregnancy with the carbon dioxide laser. Am J ‘Obstet Gynecol 1984; 148 : 9-12, 3. Roman A, Fife K: Human papillomavirus DNA as- ‘sociated with foreskins of normal newborns. J Infect Dis 1986; 153 ; 855-61.